Back Muscles: Structure, Strengthening and Stretching

Almost everybody has experienced back pain or tightness at one time or another.  Limited flexibility, chronic aches and time lost from work are some of the consequences of this ailment.  We strive to stay ahead of this disabling situation, but we are affected by it for a variety of reasons.    They may include weak muscles, muscular imbalance, over-exertion and fatigue. Our posture, range of movement and even our moods are affected by these limitations.  We will discuss the structure of the whole back muscles, both anatomically and functionally, though our focus will be on the mid and lower back. We will then provide a series of exercises for both strengthening and stretching the back muscles as a preventative measure for the future. These exercises are generally recommended, but please make sure to check with your physician before attempting them.


The back muscles are designed to direct various movements of the back (upper, mid and lower back), shoulders, neck and arms, provide protection of the spine and maintain an erect posture.  They can be divided into three groups, based on their location and associated movements. The Superficial group is located along the mid to upper back and include the Latissimus Dorsi, Trapezius, Levator Scapulae and Rhomboids (Major and Minor).  Their functions involve movements of the shoulders, scapula, arms and neck.  They can be viewed in Figure 1.  The Intermediate group includes the Serratus Posterior (Superior and Inferior).  They are associated with the movements of the rib cage.  The Deep group includes the Iliocostalis, Longissimus and Spinalis, collectively known as the Erector Spinae.  They are the longest muscles in the back and run parallel and on each side of the spine (from the sacrum to the cervical portion of the vertebrae). The Spinalis lies medial to the Longissimus and the Iliocostalis is the most lateral of the three muscles.  An illustration is provided in Figure 2. The function of the Erector Spinae is to extend, flex and laterally flex the vertebral column. Back pain tends to be located in the lower back region and these muscles need to be highlighted for strengthening and stretching  purposes.  

Fig. 1

Fig. 1

Fig. 2

Fig. 2

Strengthening exercises

A series of two strengthening exercises provided below illustrates some easy weight lifting or core strengthening movements.

Reverse Fly

Stand tall with feet shoulder width apart, back straight with knees slightly bent.  Hold a five to eight pound dumbbell in each hand, palms facing in and hinge forward at the waist.  Bend elbows slightly and raise the weights out to the side, as far as you can.  Return to starting position and repeat 2 sets of 16 reps. (Fig. 3)

Fig. 3

Fig. 3

Opposite Arm and Leg Reach

Start on your hands and knees.  Reach your right hand forward while, at the same time stretching your left leg backward (and toes flexed).  Hold for 5 seconds then release and repeat using the opposing arm and leg.  Repeat this sequence 10 times. (Fig. 4)

Fig. 4

Fig. 4

Stretching exercises

Knee to Chest

Intended to stretch the lower back and glutes.  Lie flat on your back and slowly bend your right knee, pulling your leg to your chest. Wrap your hands around your knee, holding that position for 20 seconds.  Return your leg to the starting position and repeat the sequence for each leg. (Fig. 5)

Fig. 5

Fig. 5

Lumbar Traverse

This exercise is intended to stretch the Paraspinal muscles.  Lie flat on your back with legs extended.  Bend your right knee and cross it over the left side of your body.  Hold that pose for 20 seconds and return to starting position.  Repeat this sequence for each leg 3 times. (Fig. 6)

Fig. 6

Fig. 6

Child’s Pose

This is a restful common pose in Yoga, meant to relax and decompress the lower back.  Position yourself on the floor on your hands and knees, with knees splayed outward (wider than hip distance apart).  Turn your feet inwards to touch and push your hips backward resting them on your heels.  Extend your arms forward and allow your head to fall forward in a relaxed manner.  Hold for 20 seconds and then return to starting position.  Repeat this sequence 3 times.  (Fig. 7)

Fig. 7

Fig. 7

A regular routine of strengthening and stretching of the lower back muscles can help avoid back injury or alleviate the pain when it occurs.  It should not be a debilitating condition, though it is quite common.  Massage is a valuable resource to help in relieving hypertonic muscles, decrease pain and discomfort and also increase range of motion.  A massage session will often incorporate some of the stretches listed above, if applicable for your needs.  A massage therapist can assist you, to supplement the measures you may have already undertaken.


  • Fig. 1: (viewed 4/3/17)
  • Fig. 2: (viewed 4/3/17)
  • Fig. 3:,,20709957,00.html#reverse-fly-0 (viewed 4/12/17)
  • Fig. 4:,,20709957,00.html#opposite-arm-and-leg-reach-0 (viewed 4/12/17)
  • Fig. 5, 6 & 7: (viewed 4/12/17)
  • (viewed 4/3/17)
  • (viewed 4/12/17)
  • (viewed 4/12/17)
  • (viewed 4/12/17)
  • (viewed 4/3/17)
  • (viewed 4/12/17)
  • (viewed 4/12/17)

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Active Isolated Stretching (AIS)

Active Isolated Stretching is a stretching technique used by professional athletes and fitness coaches to increase flexibility and treat injuries.



The movement is initiated by the athlete then deepened by the therapist, to go beyond what the athlete would normally do on their own. The active participation favors muscle awareness and relaxation for more efficiency.


Stretches isolate specific muscles for more precise work than general stretching (for example, there are 6 different stretches for the 6 muscles that comprise the hamstrings).


The stretch allows for increased range of motion by lengthening muscles, fascia and increasing joint mobility.

Watch a slideshow of AIS.

How it works:

Stretches are held no more than 2 seconds, and repeated up to 10 times. After a session, the therapist teaches specific stretches for home self-care.


Stretching has many benefits:

  • Increases range of motion in those muscles that need more mobility thus reducing the risk of injury
  • Participates in the reduction of knots and muscle tightness, also reducing risks of injury
  • Provides more mobility, comfort and better posture, reduces asymmetries.

Watch our testimonial of a client who was helped in treating his IT Band syndrome with AIS.

All of our therapists have basic training in AIS and Nick is our certified AIS therapist – ask us about incorporating AIS to your next massage session. 

At the end of an AIS session, your therapist will demonstrate self-massage techniques to use at home to continue benefiting from the technique. 

Watch a hamstring self-stretching sequence with AIS

Achilles tendonitis

One of the largest and strongest tendons in the body is the Calcaneal tendon, better known as the Achilles tendon.  This tendon is responsible for helping you walk to work, run those long runs, and jump with during that HIIT workout. When you stand up on your toes or push off, this is the tendon that allows you to do so. It attaches from your calf muscles (Gastrocnemius and Soleus) to your heel (calcaneal bone) and is one hardworking tendon: when you flex your calf, it pulls on your heel. [1]Overuse, poor self-care leading to tight muscles, poor shoe choices (not enough support, old, too high…), excessive incline workouts, increasing running mileage or the intensity of your workout too quickly are some of the things that can lead to pain and injury to the Achilles tendon. If left untreated, it can turn into what is known as Achilles tendonitis or tendinopathy. Symptoms of this injury are pain, swelling and inflammation in the back of the heel or lower calf; there may also be limited flexibility in the ankle. This can be felt especially in the morning when first walking, but can be present throughout the day with varying degrees of pain and discomfort.

If these symptoms start and don’t dissipate, stop your workouts immediately. Any activity that aggravates your symptoms should be put on hold until this injury subsides. Until you can complete toe raises without pain, don’t resume intense activities. The RICE method is recommended (Rest, Ice, Compression and Elevation) right after the injury occurs. Your doctor will generally recommend Ibuprofen to reduce the pain and inflammation. Splints and or taping can also be beneficial. A visit to the doctor for proper diagnosis is also important.

Once through the initial acute phase, low impact activities such as the elliptical, swimming and biking can help resume activities without being too stressful on the lower leg. Gentle stretching, foam rolling and massage of the calves are great ways to loosen the muscles in the lower legs and reduce the stress on the Achilles tendon.

Some stretches that have been shown to be beneficial are eccentric heel drop, Soleus stretch and Gastrocnemius stretch, shown below.

Eccentric heel drop:

[2]Stand on the edge of a step and lower yourself slowly and in control (try a slow count of 4 or 5) on your injured foot, essentially exerting force as the muscle extends.

Then use your other, non-injured, foot to raise yourself back up, so as not to stress the tendon in the rising motion.

Do 15 repetitions, twice a day.


[3]Soleus stretch

With your knees bent, and the leg that needs to be streched behind gently lean forward while keeping the rear heel down.

Do 15 repetitions, hold each for 15-20 seconds.  Repeat twice a day.

Gastrocnemius stretch

[3]With straight legs and the leg that needs to be stretched behind, gently lean forward while keeping the heel down.

Do 15 repetitions, hold for 15-20 seconds each.  Repeat twice a day.




If these methods don’t alleviate the problem, your doctor can recommend the next steps.  Self-care should be an important part of every person’s routine, especially athletes.  With proper self-care of your lower legs, stretching, listening to your body, foam rolling and massage, you can aim to stay healthy and injury free.


Picture references:


References (viewed 2/27/17):


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Sinus Inflammation and Massage

This time of year we are exposed to all sorts of nasties, which can leave our sinuses in overdrive. Changes in temperature, environmental allergies and illnesses can all contribute to sinus inflammation. If you are one who suffers from sinus inflammation, you will know that it can be difficult to function normally when symptoms rear their ugly heads! Sinuses are air-filled sacs that clean the air that we breathe through the nose. They lighten the bones of the skill, and provide shape to the face. Allergies, infections and physical obstructions can cause the sinuses become inflamed or swollen. (1)


There are four sinus points located above, either side of, and behind the nose. The sinuses are named after the bones of the skull in which they are located (2).

image [2]Frontal Sinuses: located on the center of the forehead above the brow-line of each eye, on the frontal bone

Ethmoid Sinuses: small air sacs located on either side of the bridge of the nose. The Ethmoid bone separates the nasal cavity from the brain

Sphenoid Sinuses: located deep to the nose, near the optic nerve on the Sphenoid bone

Maxillary Sinuses: located behind the cheekbones near the Maxilla or upper jaw

image [1] 

Causes of sinus inflammation

  • Viruses, bacteria and fungi: cold or flu
  • Structural problems: deviated septum, nasal polyps can obstruct the flow of mucus and block drainage (3)
  • Environmental irritants: indoor and outdoor pollutants, grasses and pollens, certain foods


  • Headaches
  • Tenderness in the affected area
  • Swelling and puffiness around the eyes
  • Runny or congested nose
  • Facial or tooth pain
  • Fatigue


When inflammation occurs, pain may also be present in the surrounding muscles of the face, the upper neck and the jaw. In structural and environmental cases of sinus inflammation, gentle massage around the face and neck will help to drain the sinuses and relieve pressure from the affected areas.

If a fever and infection is present, massage can exasperate symptoms. In this case it is best to wait until the fever has passed before bodywork is performed. (1)

See our article on ‘Cold, Flu and Massage’.

Self care massage for sinus relief

  1. Set yourself up in a comfortable position, preferably supporting your head and neck.
  2. Spread your fingers wide, place your fingers and thumbs around your scalp line and gently move your fingers in small circles
  3. Have your fingers meet in the center of your forehead, slowly drag your fingertips towards each ear (frontal sinus)
  4. Take your index or middle finger and slowly draw small circles along your eyebrow line, starting from your nose and gently migrating laterally towards each ear (frontal sinus)
  5. Bring your middle fingers back to the bridge of your nose. Find two little nodules, where your nasal bone meets the frontal bone. Hold a firm pressure for 10-15 seconds. (Ethmoid sinus)
  6. Move your fingers back to the bridge of your nose. This time, drag your fingers down each side of your nose (sphenoid sinus)
  7. Take a flat finger on either side of your nose, and gently drag along each cheek bone towards your ears (maxillary sinus)
  8. Small circles on the temporalis, (clench the jaw to locate the temporalis muscle)
  9. Firm pressure on the temporalis, slowly push your fingers away from your face (towards the back of your head) as you slowly open your mouth
  10. Small circles around the ear, (TMJ, Coracoid process and temporalis tendon)
  11. Gently pull your ears for a temporalis release


  1. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 332
  3. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 333



This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Changes to your membership, March 1st, 2017

Dear Members, Phila Massages has been in business now since 2010 and we are grateful to have been growing ever since. To align with the increasing cost of business and in order to continue providing the top quality sports massage that you enjoy, our rates will increase for the first time since introducing our membership system. The changes listed will take place March 1st, 2017.

At Phila Massages, we always put our members first. While our overall rates are changing, we plan to implement two great promotions. First, the rates at our Manayunk location will be discounted by $10 throughout 2017 (making the rates there the same or even lower than in 2016!). Our second discount is to reduce our PTSM rate so that more of you can enjoy it (if you haven’t already, try it out this year!).

We are excited to promote out calls for athletes and athletic teams in the Philly area; we have been doing out calls since we opened but we are now promoting this service as our expanded team is able to be more mobile. The number of member guest passes will increase so that you can benefit from one for each membership month; they will no longer be member rate but 25% off for family or friends.

Additionally, over the winter we will be sprucing up our Rittenhouse location and transitioning into a new logo – look out for those exciting changes!

We understand that this is a modification of your current membership, so if you wish to cancel your membership, you can do so at no charge or with a pro-rated refund between now and February 28th, 2017. To do so, simply email

As of now, we have a fantastic team of 12 massage therapists all dedicated to their sports massage career and helping you in your athletic goals; we look forward to working with you this year!





If you have any questions about these changes, please don't hesitate to email us:

Take a deep breath and improve your athletic performance

Do you want to shorten recovery time, increase stamina, decrease stress, sharpen your focus, and improve your athletic performance? Take a deep breath and read on! As athletes, the importance of breathing is often overlooked. After all, everyone breathes all day every day, so why think about it? This blog post will explore some breathing techniques to help elevate performance, discuss the benefits that one can obtain by using those techniques and how massage can participate in more efficient breathing.

Recent studies have shown diaphragmatic and nasal breathing techniques could improve athletic performance. Diaphragmatic breathing may increase the antioxidant defense status in athletes after exhaustive exercise [1], activate the parasympathetic nervous system to calm nerves, decrease stress and muscle tension [2], sharpen focus, reduce fatigue, and promote stamina [3]. Nasal breathing on the other hand allows the body to take in and process oxygen 20% more efficiently during exercise and protects the lungs from cold and polluted air. For athletes specifically, these two techniques could increase physical performance, focus, mental performance and shorten recovery time [4]. In the video below we will teach you these two techniques so you can improve your breathing and athletic performance.

So where does massage come into play when it comes to breathing? Most people know that the lungs allow us to breathe but don’t usually think about the muscles that allow the lungs to function. The diaphragm is the main muscle that allows humans to inhale (inspiratory) and the abdominal muscles primarily allow humans to exhale (expiratory). A number of smaller muscles also assist in breathing as seen in the diagram below. Any restrictions we have in these muscles can impede breathing and thus harm athletic performance and recovery. Asking your massage therapist to incorporate techniques that target these muscles in your sessions can help to remove those restrictions and allow more effective and efficient breathing for improved performance.

[11]Want more information on massage for the diaphragm and abdominal muscles?




This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.



The Importance of SI Joint Function

What is the SI Joint? The sacroiliac joint or SI joint is the joint that connects the sacrum with the pelvis and is located on each side of the lower spine.

Ref. 1

The SI joint’s main job is shock absorption.  It does this by transferring the forces of the upper body to the lower body, which includes the hips.  This is a very stable joint due to its anatomical configuration and strong ligaments. There are also strong muscles surrounding or reinforcing the joint such as erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles, and hamstrings which all make it even more stable.  

Despite being so stable the SI joint is in fact a mobile joint, though minimally, which allows it to perform proper shock absorption during weight-bearing activities and motions.  We will get to this in a moment.

Why Is This Joint So Important?

The most pivotal responsibility of the SI joint is to limit stress and force between the hip and lumbar spine.  It does this by anatomical configuration and its shear strength.  This comes to play in many daily situations such as standing, walking, sitting, lifting heavy objects, or exercises such as performing squats and jumping activities.  

SI Joint Dysfunction

Now that you have learned a little about the SI joint and its significance, it is just as important to know what happens when it is not functioning properly.  

SI joint dysfunction is one of the leading causes of low back pain.  It is often hard to diagnose initially because the symptoms are similar to sciatica or lumbar disc herniation, but it is usually found during  physical examination that includes movements.  Inflammation at the joints is also common in SI joint dysfunction.  The causes of SI joint dysfunction, however, are varied but fall into the category of hypermobility (instability) or hypomobility (stiffness).  This goes back to an earlier point, which is in order for proper shock absorption, the joint needs to stay mobile but can not become overly mobile to the point of instability.  

Symptoms include: pain on one side (more common) or both sides of the body, pain in the lower back and/or hip, pain in the thigh and/or glute, pain that radiates down the sciatic nerve (similar to sciatica), groin pain, and is most common among young and middle-aged women.  It can cause painful sitting and difficulty getting out of bed or car without experiencing pain.

How to Prevent or Treat Dysfunction

In order to prevent SI joint dysfunction from occurring, it is important to know the causes of instability or stiffness.  In most cases, the cause is due to muscle imbalances.  These muscle imbalances can include weak glutes, hips, hamstrings, core, and lats.  Not only is hip strength and stability  important, but also mobility.  Other causes are poor posture such as leaning more to one side, running which creates a repetitive pounding on the joint, repetitive or violent twisting motions, and pregnancy due to hormones being released in the body that cause your joints to become more mobile and loose.  If chronic back pain occurs it is always important to find the cause and location before any specific treatment is to be performed.  

Now that you know you have SI joint dysfunction, how do you fix it?  The combination of massage, stretching, and exercise techniques are effective ways to treat this.  The role of a licensed massage therapist would be to increase mobility in the areas of tightness that are causing the SI joint to become stiff, one of the two main causes of SI joint dysfunction.  They would be targeting the  imbalanced muscles previously talked about while also increasing blood flow to the joint to promote healing.  Your LMT may also recommend stretching for self care in conjunction to your sessions.  Here are two examples of stretches:

1 - Prone on elbows 

With this stretch you want to make sure your elbows are aligned with your shoulders and tilt up with your palms until you feel it in your lower back


2 -single knee chest stretch

With this stretch you simply want to extend the opposite leg and bring the other leg to your chest and hold.  You could also use shorter holds and alternate which turns this into more of an exercise/dynamic stretch.



If you have never had SI joint dysfunction or have had it and do not want a relapse, adding strength training to your massage and stretching routine is key. The 3 areas that you would focus on are:

1 - Glute strengthening and activation exercises (see Ref. 2 for an example)

2 - Hip strengthening exercises (see Ref. 3 for an example - Make sure your back stays straight and head and feet are facing forward) 

3- Core strengthening exercises. A good example is a forearm plank (see Ref. 4); although basic, it is a very effective exercise to strengthen your core. Make sure you are contracting your abs and lifting from the toes. Hold for about 60 seconds or as long as you can during each rep. 

There are also several other exercises that you can do at home to address the SI joint.  See Ref. 5 for a video demonstrating 3 common exercises.

Lastly, use proper posture and focus on sitting properly, making sure in particular that you are not leaning on one side more than the other, and practice self-awareness.


References (retrieved 10/28/16):


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Runners keep your BALANCE in check!

If you are a runner and are work with me, you may notice me asking you many questions during our session.  This is because I want to be sure you are doing everything possible to prevent muscular imbalance and injury.  It seems runners just want to run, however, let’s face it, you must do your homework as well.  Balance and lower leg/foot strength ( along with massage and foam rolling) are some of the key ingredients to improving AND keeping muscle tissue healthy.  Runners who have an impaired sense of balance are at an increased risk of injury by tripping and falling, says Kevin McGuinness at Washington Orthopedics & Sports Medicine.  If you have an impaired sense of balance or compensation due to overuse it may cause injury. If you are having issues simply balancing on one leg while just standing, imagine how much more difficult it is on your body while bounding from one leg to the next! Need to be further convinced to improve your balance?  Here are 4 reasons:

  1. Who doesn't want Herculean ankle strength?!
  2. It will also improve your sense of awareness and proprioception.
  3. It will improve your single leg balance (aka run).
  4. This does not require much equipment, if any.

Some ideas for strengthening feet for balance:

  1. Ditch your shoes. Start by walking around your house barefoot, and once you gain strength there then work your way up to some barefoot exercises.
  2. Running in sand to work through joint articulation in the feet and increase strength and flexibility.
  3. Walking on rocks. This will get the proprioceptive nerves in your feet going and will help prevent back pain.
  4. Roll out the three arches of your foot. You can use a lacrosse ball frozen water bottle etc. Here be sure to include your lateral (outside) arch, transverse (center) arch, and medial (inside) arch. You will most likely feel pain in your transverse arch taking extra care when you move close to the heel as this area may be very sensitive.
  5. Use balance boards, bands and balance trainers. The picture below is an example of an exercise I recommend frequently to my running clients for muscular balance in the lower leg. You may also place your ankles on a foam roller or a throw pillow to lift your heels off of the ground.  Attach the other end of the band to heavy furniture or weights or have someone stand on it.

ref. 5

Since running involves dynamic movement it makes sense for us to improve our dynamic balance training.  Check out these videos below for some examples of dynamic balance training that requires absolutely no equipment:

    1. This exercise may prove to be tougher than it looks for some.  Try to keep control on one leg and stabilize the foot, ankle, knee and hip while drawing the letters of the alphabet A all the way through Z by dynamically moving the arms.

  1. If you have mastered the previous exercise then you may want to attempt the single leg “hop and “hold” for more difficult single leg dynamic stability.

You will find that this article will provide you with many additional ideas for exercises to improve run strength.  This includes improving optimal power, core strength, lateral movement, upper body strength, leg strength, stabilization and posture.

Focusing on some of the exercises presented above a few times per week in addition to your runs will aid in injury prevention, keep muscle tissue healthy and will even improve overall strength and the quality of your runs. If you are looking for any additional ideas for balance exercises I am happy to share more of them with you during our next massage therapy session.  Stay balanced!!!


References (Retrieved 10/4/16)


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Two Minutes A Day For A Healthier Spine

Spinal hygiene is often compared to dental hygiene. Similar to teeth, the spine can develop disorders and deteriorate. The  only difference is that if there is dysfunction or decay, it is more difficult to replace the spine than it is to install dentures in someone's mouth. The spine protects the nervous system in the body and the nervous system controls every function in the body. For example, the nervous system tells the body to breathe and it tells the heart to beat which are both vital functions to sustain human life. They also tell the muscle fibers when to fire during movement and when to relax when not moving. Spinal Hygiene Exercises are important because they help prevent spinal dysfunction.  When practiced daily these exercises improves posture, repairs and maintains muscular strength, range of motion, and encourages a healthy nervous system. In fact, a study measuring the quality of life (a health-related concept) concludes that spinal hygiene exercises improves the quality of life (Shepard 1).

Spinal hygiene exercises should be done daily as part of a morning and/or evening routine. When practicing spinal hygiene exercises maintain an even breathing pattern, go as far as the body will allow, and notice the body's posture.  Are the shoulders elevated? Is the head in a forward position? Is the pelvis tilted forward? Are the knees extended? Become aware of the body and make necessary adjustments whether you are walking, running, sitting, or standing.

Spinal Hygiene Exercises (TWY)

T- Hold arms out with palms up. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still out. Repeat 3 times.20160901_085955

W- hold arms out with palms up. Bend arms at the elbows at 90 degrees. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.


Y- Hold arms up in the air with thumbs back, palms facing each other. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.


References (Retrieved 8/29/16)

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Sleep It On, Don’t Sleep On It (Best Sleep Positions)

Sleep: The Benefits Sleep can be your muscles greatest training ally. True rest can be the most beneficial thing in a persons training regimen because the body actually builds muscle while you sleep. As the body falls deeper and deeper into sleep, passing from a state of beta rhythm (conscious alert state) through alpha and theta, to delta rhythm (deep sleep/ REM sleep state) the brain signals the paralysis of the skeletal muscles and the pituitary gland secrets the peptide hormone Somatotropin (Also known as growth hormone).

The Hormone Behind the Muscle Building

Somatotropin stimulates muscle growth, cell reproduction and cell regeneration. Essentially, using this hormone, muscles broken down through training are rebuilt and improved. Somatotropin is found in its highest levels in the body during delta rhythm sleep. Therefore an athlete is not optimizing training/recovery without getting optimal sleep.

Lack Of Sleep: The Drawbacks

Sleep or lack there of can also be very detrimental to the body, without the signals from the brain to paralyze the muscles into a complete resting state, the body would continue to break down further due to the muscles reaction to the stimuli of the dreams experienced during sleep. This may occur due to noise pollution in an individual's sleeping environment and or poor sleeping habits, which leads to the question 'which is the best position in which to get a good, restful, muscle repairing nights sleep?'

The answer to that question may not be the most simple. Every sleeping position has its pros and cons.

Positions: Pros and Cons

For instance those who prefer to sleep on their Back benefit from the alignment of the spine and neck while at the same time they are putting pressure on the lordoses of the neck and lower back and the muscles that support them in addition, they are at a higher risk from respiratory restriction or sleep apnea. One solution to this problem is to discontinue the use of a traditional pillow; this forces the head to tilt back allowing the respiratory tract to remain fully open like in the use of CPR.

Areas under pressure and fixes:



Side sleepers can benefit from increased circulation to the heart by sleeping on the left side but at the same time they are putting pressure on the stomach and lung and lateral pressure on the lower back, cervical vertebrae and muscles of the neck, while most likely restricting blood flow to the arm on that side as well. Alternating the side (night to night) that one sleeps on is suggested in order to prevent putting too much strain on the muscles and organs of one side or the other for extended periods of time.

Areas of pressure and fixes:

Pic. ref. 1


Stomach sleeping, widely regarded as the worst position to sleep in can be beneficial in digestion (shown in some studies) and decrease the chances of sleep apnea, but the negative affects on the spine and muscles of the back (specifically lower back, this position usually causes the greatest strain in this area) and also the muscles of the neck do to the angle the neck is bent when using a pillow; seem to outweigh any possible benefits from this position.

Areas under pressure and possible fixes:

Pic. ref. 1


Block out that white noise, find a comfortable sleeping position that allows you a good night’s sleep, without putting too much strain on those tired muscles and sleep on the gains you’ve been training for.


References (retrieved 7/27/16):


Picture References (retrieved 7/27/16):


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Neck Pain: Where is Your Head Right Now?

Neck pain is one of the most common complaints we see as massage therapists. And in a world where most people spend the majority of their day on a computer, that’s no surprise. In fact, if you’re reading this blog post, you’re on a computer right now. Time for a pop quiz: Where is your head right now?

Picture 1

Is your head directly over your shoulders? Or is it slightly forward - or even a lot forward? Are you looking straight ahead of you, or is your head tilted down to see the screen?

As a nearsighted person, I have terrible computer posture because I’m always leaning forward to get a closer look at what I’m doing. And as I get tired, my shoulders slump forward and my whole spine rounds forward. When I work at a computer for more than a few hours, my neck turns into one big ache.

But it’s not just our work on computers that can impact our neck. Hobbies and sports can take their toll as well. Cyclists have to have their shoulders down and head up to have proper posture on the road, and this creates chronic compression in the back of the neck. Swimmers are also prone to neck pain, because of the twisting motion required to breathe during the freestyle stroke. Triathlon training is basically a recipe for neck pain - which is why we recommend daily stretching and self care routines for triathletes, office workers, and anyone else who experiences frequent neck pain.

Stretches & Self Care for Neck Pain

These stretches should be done every day for optimal results. As with any home stretching routine, proceed carefully, respect your body’s limits, and stop immediately if you feel a sharp, shooting pain.

  1. Doorway Stretch

This is the stretch I give as “homework” to most of my new clients. It targets the pectoral muscles, which in most of us are too short and too tense. Tight pectorals restrict and shorten the muscles in the front of our neck, and cause pain in the back of the neck and between the shoulder blades.

To perform this stretch, stand in a doorway and anchor your elbows in the door frame on either side of you. Slowly lean forward until you feel a stretch in the front of your chest. Hold for at least 90 seconds.

Picture 2


For a more relaxed version of this stretch, try the “Heart Bench” from Martin’s recent blog post, Use it Or Lose it: How Age Affects Flexibility.

  1. Anchored Neck Rolls

This exercise can also be done in a doorway, or it can be done sitting in a chair. For this exercise, shrug your shoulders back and down your back, and then hold onto the seat of the chair or the edges of the doorway in order to help your shoulders stay in place. Then, gently begin to roll your head counterclockwise on your neck. Let it drop forward, then to the right, then slightly back, and to the left, and forward again. Take deep breaths and pay attention to any areas of tightness. When you find a stretch that feels good, stay there for 30 seconds to 2 minutes. You can even use the opposite hand to gently assist in the stretch.

Picture 3


  1. Tennis Ball Massage

Tennis balls make wonderful self-massage tools. You can lie on the floor and place tennis balls right where the skull rests on the neck, moving your head back and forth to feel the massage. Tennis balls also feel great at the junction of the shoulder and neck, and right between the shoulder blades. You could even lie face down and place the tennis ball just inside your armpit for a nice pec massage.

Picture 4


Other Tips

Hot and cold compresses can feel wonderful on a sore neck. Try putting a towel in the freezer, or investing in a Magic Bag, Bed Buddy, or other similar hot/cold wrap.

Over-the-counter pain medications such as Advil, Tylenol, or aspirin can be helpful, but taking too many of them can have a variety of adverse health effects. If you find yourself needing to take pain medication regularly, talk to your doctor. And always let your massage therapist know if you’ve taken pain medication before you come in for your massage.


References (retrieved 6/27/16):


Picture References (retrieved 6/27/16):


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Shin Splints Or Medial Tibial Stress Syndrome

IMG_2102Shin splints are a common sports injury, especially amongst beginner runners or those starting a new high impact activity. Maybe you’ve had them at some point: it is a pain in the lower leg, along the inner part of the tibia.In spite of the fact that they are so common, there isn’t a clear histological description of shin splints. However, in most cases, conservative treatment seems to be effective, and there are known preventive measures that work.


When the term was originally coined, shin splints referred to any pain in the lower leg. Now, there are multiple diagnosis for shin pain and the term shin splints is generally reserved for Medial Tibial Stress Syndrome (MTSS).

MTSS creates pain in the inner part of the shin, along the Tibial bone. It is usually spread over at least 5 cm (2 in) and there may or may not be swelling involved. There is no consensus on the physiopathology of shin splints, some saying that it is caused by micro-tears in the soft tissue attaching to the Tibia (Tibialis Posterior muscle, Soleus, or Interosseus Sheath), others say it's periostitis (inflammation of the connective tissue that surrounds the bone), while others believe it is the bone itself that is overloaded, resorbing itself faster than it forms.

Risk factors


Shin splints are a sports injury linked to overuse.

Extrinsic risk factors include:

  • Repetitive high impact sports (running, gymnastics, basketball, …)
  • Over-training
  • Sudden increase in intensity or distance
  • Less running experience
  • poor or hard running surfaces
  • improper footwear

Intrinsic risk factors include:

  • Over-pronation of the foot (flat feet)
  • Women are at higher risk
  • Past shin splints
  • Being overweight or having weak calves may be contributing factors


  • Rest for several weeks from the activity that causes pain. Gradually return to that activity after being completely pain-free.
  • Pain relievers or anti-inflammatory medication may be advised by your doctor.
  • Compression such as compression socks or calf sleeves help relieve symptoms.
  • Icing the area participates in decreasing inflammation and provides pain relief. Ice 20min several times a day.

Note: some compression sleeves have pockets for ice so that compression and icing can be combined in one step [11]. 

  • Massage: a massage therapist will loosen the lower leg muscles and eliminate knots to decrease the load on the tibia. Work will be focused on the calf and the Tibialis Posterior. The session will include deep tissue massage, cross fiber friction and stretching to those muscles. Care will be taken to avoid the bone itself, so as not to aggravate it or the insertion points of soft tissue. At the end of a massage session, your therapist will recommend self-care exercises that may include:
    • Self massaging the calves with a foam roller (see photo A, below)
    • Self massaging the Tibialis Posterior with your thumb (see photo B, below)
    • Gastrocnemius (superior and more superficial part of the calf) stretching (see photo C, below)
    • Soleus (deeper part of the calf) and Tibialis Posterior stretching (see photo D, below)

(A) Place your calf on the foam roller, with the other leg on top. Lift your hips and roll your calf up and down the foam roller, as well as side to side.









(B) Use your thumbs to massage the soft tissue by the tibia. Apply circular motions for 2-3 minutes with medium pressure.








(C) Place the front part of your foot on the edge of a stair and let the heel fall, stretching the calf. Your knee is straight.









(D) Place the front part of your foot on the edge of a stair and let the heel fall, stretching the calf. Your knee is bent.



  • Changing shoes: while advocates of barefoot running claim it is helpful for shin splints, there is no evidence to support this. On the contrary, using arch supports or changing to shock-absorbing insoles seems to be a more effective way to prevent shin splints. [4]
  • Gradual increase in work-load: make sure to follow a training program adapted to your level and to increase intensity gradually. If you miss several weeks of training, don't "jump" to where you should be or do a lot to make up for the missed weeks, but rather build progressively from where you are.
  • Cross training: a balanced fitness regimen consists of 3 components: cardio, strength and stretching:
    • Cardio: consider switching one or more of your high impact workouts for another cardio workout that is less stressful on your Tibia. For instance, a runner may consider switching one of his/her runs for cycling or swimming.
    • Strength: strengthening your leg muscles with exercises such as squats and lunges will help provide support to your lower leg structures. One-legged exercises or exercises on an uneven ground (such as on a Bosu ball) will target more specifically the lower leg stabilizers. A physical therapist might also prescribe targeted Tibialis Anterior (see photos E and F, below) (this muscle is at the front of the lower leg – strengthening it will counter-balance tight calves) or calf strengthening exercises (strong calves protect the Tibial bone).
    • Stretching the lower leg muscles will decrease their tightness and the appearance of knots: stretch your calves and Tibialis Posterior, actively before an activity, passively after.
  • Massage therapy: regular massage sessions can help keep muscles loose as a preventive measure.

(E) (F) Place your back against a wall, your feet away from the wall. Lift your toes so as to contract the Tibialis Anterior, then place on the floor. Repeat 10 times and do 3 sets.






For runners, I recommend heading to Philadelphia Runner [12] to purchase appropriate footwear. All the staff are experienced runners who will be able to assess your gait and provide adequate shoes. They also created Team Philly [13] (for which Phila Massages is a partner) that offers training programs, weekly group runs, running questions support, access to a Physical Therapist, ...

Other shin pains

Some practitioners may consider only MTSS to be shin splints, others may use the term for other conditions, some of which are described below, while others still may use the terms "true"/"false" or “anterior”/”posterior” shin splints depending on the shin pain - there currently is no medical consensus on the term “shin splints”.

Chronic compartment syndrome

This condition is rare: pain is usually located in the front part of the shin. It is caused by bleeding or inflammation of the lower leg muscles. These muscles are encased in a tough fascia and if that fascia is too tight, these changes increase the pressure in that area, causing pain. Pain decreases when stopping exercise, numbness can occur. Treatment is similar to that of MTSS except the target muscles/areas will differ.

Note: acute compartment syndrome is very rare and is caused by dangerous pressure elevation in the lower leg. In this case, the pain is acute, increases, and doesn’t go away after rest: it is a medical emergency.


Tendonitis is an inflammation of a tendon: Tibialis Posterior, Tibialis Anterior or Peroneus can be culprits. Treatment is similar to that of MTSS except the target muscles/areas will differ.

Stress fractures

A differential diagnosis for shin splints may be a stress fracture, which is a small crack in the Tibia. Pain is not spread, can be pinpointed to a specific area, and doesn't improve after treatment recommended for the above conditions. It is diagnosed by an MRI (though doctors might choose not to do this expensive imaging and diagnose only by a clinical evaluation) and generally requires a boot for 6-8 weeks.

Because there is no consensus on the definition and etiologic factors contributing to shin splints, treatment can be challenging, stressing the importance of prevention. If you think you have shin splints, and as with any other sports injuries, make sure to see your doctor first. Then, if it's appropriate, the Phila Massages team will be able to help you with your recovery or for prevention.


References (retrieved 5/20/16):

  11. An example of Compression and icing gear (I found this while doing a search on Amazon – I have not personally tried it and am inserting the link to illustrate the type of product mentioned): 110 Percent Play Harder Double Life Shin/Calf Compression Sleeves + ICE for Shins and Calves, Black, Size 1, X-Small
  12. Philadelphia Runner:
  13. Team Philly:

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Use It Or Lose It: How Age Affects Flexibility

We all remember that test in gym class, the famous V-sit and Reach. The one that had us sit upright as we effortlessly bent forward at the waist reaching out beyond the tips of our toes to the floor beneath us. Fast forward a few decades later, and how many of us would now consider ourselves lucky to settle for half of that? Maybe it’s the shins, or maybe just grasping hold of the knees is taking it to your edge. What changes do our bodies go through over time that makes our flexibility weaker and weaker as we age, and how do we prevent this? Components of flexibility

The musculoskeletal system is arguably the most complex system in the body, composing of the bones, muscles, cartilage, tendons, ligaments, joints and other connective tissue that provides support, stability, and protection to the organs. Many different actions need to happen in order to activate a simple muscle contraction. Muscles are able to contract, lengthen and stretch because of their unique physiology, a property called elasticity. As the human body ages, or if we do not utilize its need for movement,  it loses this natural ability to stretch and restore itself, slowly limiting range of motion and eventually leading to chronic tightness.

Variable factors such as muscle loss, lifestyle habits and the breakdown of cartilage between the joints also play an important role in flexibility and general mobility. Joints are the meeting point of two bones. Instead of each bone coming in direct contact with one another, a padding of cartilage and synovial fluid comes between the two ends. Over time, the fluids and cartilage begin to decrease and wear away. This explains why it becomes more difficult to become limber as we age. In addition, minerals may build up around the joints, a process called calcification, and could also contribute to stiffness. However, by keeping a persistent stretching regimen and performing light muscle bearing exercises, one could combat the effects of aging on the muscular system.

Stretch and Restore

Unlike dynamic stretching which is favored more as an active warm-up to a particular physical activity, static stretching involves stretching while the body is at rest and passively holding the stretch anywhere from a few seconds to few minutes. More and more yoga schools are now adapting this “yin” style into their offered courses. The benefit of holding a stretch for longer periods allows you to tap into the deeper layers of connective tissue, stimulating a healthy stretch into the tendons and ligaments and not just the muscle belly as with a quickly administered dynamic stretch. On a cellular level, you increase the production of hyaluronic acid (HA) which has the same lubricating effect for your joints as motor oil has for your car. While both forms of stretching may slightly differ in approach, both remain to be a vital component for maintaining flexibility and healthy range of motion. Below are some examples of yin stretches. Keep in mind this is a more passive stretch, meaning you want come into the stretch at your comfortable max, or about 70%. You should be able to stay in each pose without fidgeting for 3-5 minutes. Props such as yoga blocks and bolsters are encouraged to enable you to fully surrender into each stretch.  Also keep in mind that there are plenty of other ways to stay active and one should experiment with different types of exercise.

Over time, the changes to our musculoskeletal system result more from disuse and our inclination to become more sedentary than from aging alone. Which is why if don’t use it, we lose it!

Pose: Pigeon (aka Sleeping Swan)

Areas of focus: outer hips/glutes

Variation: Bolster or block underneath hip

Picture1 Picture2 Picture3 Picture4

Pose: Wide-Legged Child’s Pose

Areas of focus: Inner groin/mid back

Variation: Thread arm through with upper body twist. Area of focus: Upper mid-back/shoulder blades

Picture7 Picture6

Pose: Dragonfly

Areas of focus: Posterior legs

Variation: Sitting on bolster to elevate hips and/or bolsters underneath both knees. Block to rest your head

Picture8 Picture9

Pose: Saddle

Areas of focus: Anterior legs

Variation: Pillow behind the knees

Picture10 Picture11 Picture12

Pose: Heart Bench

Areas of Focus: Upper chest

Setup: One block between shoulder blades, one at the base of skull

Picture14 Picture13

Sources (retrieved 5/4/2016):

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Understanding Hamstring Strains: “POP!”

Hamstring strains, or tears, are a common occurrence in runners and sprinters.  There are several contributing factors to hamstring strains and there is a high chance of recurring injury.  Strains in the hamstrings are more frequent than in some other muscles for several reasons: muscle imbalance, excessive neural tension (tonus), lack of flexibility, fatigue, and insufficient warm up are just a few of the factors that play a role in this type of injury.  Anatomy

Fig. 1

Depicted is the back of your right leg

Before I go any further, I’d like to explain the location and function of the hamstrings.    They are three muscles on the back of your thigh, between the pelvis and the knee.  All three of these muscles begin, or originate, at the Ischial Tuberosity (your sitting bone).  The first muscle you see in the picture above is the Biceps Femoris (BF).  The BF is logically named because it has two heads; the long head and the short head. The BF terminates, or inserts, at the head of the fibula (outside of your knee), and is the more common location of hamstring tears.  The second muscle depicted above, the Semitendinosus, is located more medial than the others.  This muscle terminates just below the inside of your knee. Finally, the Semimembranosus, is located between the others.  The end of this muscle is also just below the inside of your knee.

You can feel all three of these muscles while sitting down.  Just reach behind your knee and you’ll feel a hard tendon just above the knee, on the outside.  You will feel two other tendons on the inside of your knee.  The BF is on the outside, by itself, and the other two are on the inside.

Usually, strains will occur at the musculotendinous junction, or where you see red changing to white in the picture above.  At the onset of injury, you will feel, or hear, a loud pop (*only for grade II strains  - most runners we see will not have that experience).  This is followed by some possible bruising to the lower leg, pain to the touch, and pain while stretching.

Role of the Hamstrings

The hamstrings are multi-articulate muscles, meaning that they provide movement for several joints. The main action is extending your thigh (kicking straight behind you).  They also bend your knee and provide the rotational ability of your knee (only when it’s bent).  Any multi-articulate muscle will have a higher chance of strain, but the hamstrings are generally more easily strained than others.  As stated above, this is due to several factors.  We will stick with the most frequent cause of hamstring strains: muscular imbalance.

Cause of strains: muscle imbalance

Located opposite the hamstrings are the Quadriceps.  A strength or tonus imbalance between the two groups is often the cause of strains during running or sprinting.  While sprinting, just before heel contact, your hamstrings are in a fully extended position.  They are stretched out fully, while the quadriceps group is shortened.  If there is a hefty imbalance, your hamstrings may be hyperextended.  This hyperextension makes it extremely difficult for your hamstrings to contract fully.   When you hear that “pop”, your hamstrings are generally fully extended.

How to prevent strains

Prevention of this type of injury is paramount, as the chance for recurrence is high, and recovery may take several weeks or months.  Stretching will help decrease the tonus in your hamstrings, also increasing your stride length. Massage and bodywork will break up scar tissue and adhesions between the muscle bellies.  You can also help reduce strength imbalances by seeing a certified personal trainer, or coach.  Some passive stretches you can perform for self-care are explained below.

My personal favorite, a bent leg stretch, can be very effective for stretching the distal end of your hamstrings, closer to the knee.  To perform this stretch, all you need is a set of stairs.  Stand on the landing and place your target leg a few steps higher than the other. You want your hip, as well as your knee, to be at 90 degree angle.  From there, you can gently try to straighten the knee joint, while the hip joint is kept in position. This stretch is depicted below. If you want to target the BF specifically, just turn your foot slightly inward before attempting to extend your knee. This can be helpful because the BF is commonly strained.

Fig. 2

An effective stretch for the full muscle belly is the straight leg hamstring stretch.  To perform this one, stand on the landing of your stairs again and place your target leg up a few stairs so that your knee is fully extended and your hip is at a right angle in front of you.  This stretch is depicted below.

Fig. 3

As with all passive stretching, be gentle and do not “bounce” into the stretch.  After your run or training, gently hold the positions for ~30 seconds 2-3 times per side. If there is any pain during the stretch, stop.  Pain is not gain in this instance.  if you lack the mobility to perform these stretches, you can always make an appointment at our office where we can assist in increasing your range of motion.

Below, I have embedded a video, made by one of our colleagues, showing you exactly how to perform these stretches in self-care. All you need to get the most out of these mobility exercises is a strong rope, or band. When referring to the “distal” end of the hamstrings, we mean the area closest to the knee.  When referring to the “proximal” end, we are referring to the section nearest the hip.

Thank you for reading! Be safe and careful with your training, and remember to always stretch! 


  • Werner, R. (2009). A massage therapist's guide to pathology. Baltimore, MD: Wolters Kluwer/Lippincott Williams & Wilkins.
  • Salvo, S. G. (2011). Massage therapy: Principles and practice, S.l.: Elsevier Saunders.
  • Kendall, F. P., McCreary, E. K., & Provance, P. G. (1993). Muscles, testing and function: With Posture and pain. Baltimore, MD: Williams & Wilkins.
  • "Yoga Integrated Science." Yoga Integrated Science. 2016. Web. 30 Mar. 2016.
  • The Best Hamstring Building Tips And Workouts From The Forums! (2006). Retrieved March 25, 2016, from


This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Fascia-The Overlooked Connective Tissue

We view the human body in terms of a skeleton, structurally housing our muscles, organs, circulatory and nervous systems, covered by our largest organ - our skin.  There are other systems in the human body that are relevant, but a tissue that is somewhat overlooked is the fascia. The medical schools used to strip away the fascia of a cadaver and study the Skeletal and Muscular Systems; that is no longer the case.  It is gaining importance in the health field, both in its significance and means of treatment. Fascia is a band or sheet of connective tissue located throughout the body, classified by anatomical location and function.  There are three types or layers: Superficial Fascia, which blends with the various tiers of the skin;  Visceral Fascia, which encloses and suspends  the organs in the abdominal cavity and Deep Fascia, which stabilizes and separates  muscles , bones, blood vessels and nerves throughout the body.  For our purposes, we will discuss the Deep Fascia.

Fascia is composed primarily of collagen fibers, arranged in a pattern that allows for flexibility and resistant pull.  The Deep Fascia is a dense fibrous tissue that connects muscles to bones (tendons), bones to bones (ligaments) and cushions the vertebrae (discs).   So it must be durable and resilient in order to maintain this function for the skeletal system.  With regard to muscles, the fascia encloses the muscle and keeps it in the correct position.   It also separates the muscles, so they can work independently and in conjunction with each other.   The fascia provides a hydrated or lubricated surface in which the muscles glide along each other.


It may be noted in Fig 1 that the fascial webbing is one continuous network, stretching from the plantar fascia in the feet, up the length of the body to the skull.  It takes on different densities and functions, depending on the location.  For example, the Gastrocnemius muscles in the calf attach to the femur, then the fascial tissue proceeds to weave to the dense properties of the Achilles tendon ( and in turn, the tendon attaches to the calcaneus bone).

And this brings up several ways that fascia affects our athletic performance and our daily routine activities.  A component of this tissue is water and it must be hydrated regularly.

Fig 2 is a simplistic, yet necessary analogy of a sponge in which the differences between a wet, springy sponge and a dry brittle sponge are striking.  A hydrated sponge is resilient and effective, while a dry sponge is hard and more susceptible to being broken.   Another aspect of fascia is that the body must maintain movement, which coincides with the joints being lubricated with synovial fluids and maintaining hydration; an inactive lifestyle hinders the effectiveness of the fascia.  Stretching the fascia enables the encased muscles to move more easily.  The lack of stretching the muscles results in limited range of motion and freedom of movement.

Fig. 2

The remedies for maintaining an efficient connective tissue system include the regimen of regular hydration, the concept of getting up and moving around (as a change of pace during sedentary periods of time) and stretching of the muscles and in turn, stretching of the fascia.  For self-care, a foam roller is a tool that can be used on easily accessible fascia, such as the IT Band (Iliotibial Band, which is a band of connective tissue located between the side of the hip and the knee).  Lastly, a massage therapist can assist in stretching and massage in areas that a person cannot access themselves.




Nerve Entrapment: It Gives Me A Tingling Sensation

Have you ever felt that tingly feeling in your hand or down your arm?  That pins and needles feeling or even numbness?  How about a pain in your forearms or weakness of grip?  I have had first hand experience with all of these and many of my clients have as well.  We spend a lot of time on our feet and sometimes that takes all of our attention if there is pain or discomfort, but we also spend a lot of time using our hands and arms and somehow we never think to have them worked on.  If you spend any amount of time in the gym, are a weightlifter, powerlifter, obstacle course racer, a computer bound desk-jockey, heck, even runners can have this problem, you need to spend some time making sure your arms and hands are in good working order.  What I’m talking about here is peripheral nerve entrapment. What is Peripheral Nerve Entrapment?

Peripheral nerve entrapment is when nerves that enervate your extremities (e.g. your legs and arms) become compressed through either injury, muscular hypertrophy (muscle growth), or inflammation.  The most susceptible areas are going to be around joints like the wrist, elbow, or shoulder.

Common Areas and Causes of Entrapment

The most common case of entrapment that I see is of the ulnar nerve near the elbow.  Symptoms may include a dull ache in the medial tricep all the way into the forearm and outside of the hand (inside of the arm).

Photo 1

While many activities can cause this to happen the mechanism is the same: constant use of the arm in a pushing motion (e.g. pressing exercises like bench press and tricep extensions) or pressure on the area around the nerve (e.g. laying your arm on your desk edge for an extended period of time; this is more directly related to the forearm, but the prolonged bend in the elbow can effect the tricep as well.)

Another common area of entrapment is at the wrist, known as Carpal Tunnel Syndrome.  This is most commonly seen in those spending a good amount of time at a computer and while typing, rest their wrists directly on the desk.  This pressure and repetitive motion can cause inflammation in the surrounding tissue that could eventually trap the nerve causing numbness and pain.

Photo 2

Last, is the shoulder.  The common structures in the shoulder area that may cause entrapment are the scalenes in the anterior neck, the pectoralis minor, and then between the clavicle and the first rib.  Often it is a combination of these pieces that effect the nerve.

Again, many activities can cause irritation of the nerves that emanate from the neck into the upper shoulder.  Common causes may be repeated motions like throwing a ball, pressing exercises, or even holding your shoulder in the same position for a long period of time (e.g. distance runners, dentists).  Symptoms of entrapment at the thoracic outlet are pain, numbness, and tingling in the forearm and/or the thumb and first two fingers.

It is important to note that a common symptom among all areas of entrapment can be weakness in grip strength.

Photo 3

Treatments and Resolution

To restore proper feeling and function you must relieve the pressure on the nerve.  Many times this can happen just through reducing the frequency of the activity causing it.  Varying your exercises in training, trying two different kinds of sports, or taking more short breaks at work or working on a different task that isn’t typing or mouse dominant can have dramatic effects.

If you are using self-care techniques to relieve the issue you must remember that it is common for multiple muscles and bony structures to be involved in the entrapment.  Addressing all of the areas (e.g. for the elbow: tricep, bicep, and forearm) will ensure the fastest and most complete resolution of the issue.

Below you will find links to videos demoing self care tips for common nerve entrapment sites.

If reducing the frequency of the activity is not possible the next best thing is massage therapy.  By reducing what I like to call the “neurological stiffness” or the constant semi-contraction of muscle fibers that comes from a repetitive activity we can free up much needed space so that the nerve bundles can slide freely between tissues.

In the event that neither of these attempts work you may need to see a specialist to discuss other options like surgery or that your numbness and tingling is a symptom of a different ailment.  More often then not massage therapy, varied training and activity, and simply rest can resolve nerve entrapment issues.

Self-care Techniques

These are athlete related but the concepts apply to anyone suffering these issues.

Thoracic Outlet:

Elbow and Wrist:

More Neck:



Interview with a Personal Trainer

I’ve been training with Pat for over a year and during that time I have picked his brain on many topics on the training and fitness spectrum.  With his years of experience working with all levels of athletes, I thought his knowledge and insight could be beneficial to others. Short bio and fitness background.

photo 1Patrick Henigan is a nationally accredited Personal Trainer recognized by the American Council on Exercise.  He is also a nationally accredited soccer coach and Level 1 expert recognized by the Functional Movement Screen.  In addition to training many people throughout Philadelphia for the past 6 years, he plays soccer, weight trains and practices yoga.


What got you involved in fitness?

I played and coached soccer in a highly competitive program and noticed that fitness was restricted to cardiovascular workouts.  I wanted to explore the weight training aspect and see how it could improve gameplay.

Health and fitness philosophy?

My philosophy varies with each client.  I find it detrimental to have an overarching philosophy that you have to shoehorn each client to fit.  I encourage clients to work hard, and find a program that pushes them no matter their restrictions or preferences.  My philosophy is to basically get people off their butts.

Why do you feel it's important to cross train?

It's important to tick every box when it comes to training.  It's important to be strong, fast, agile and to have endurance.  Not only do you fight training boredom, you eliminate whatever weaknesses you may have.

You started adding regular massage to your fitness routine, have you noticed any differences or changes?

I have very narrow clavicles so my shoulders tend to roll forward and tighten up.  Getting a weekly massage has greatly alleviated my tight pec minors, opened up my shoulders and allowed me to stand at proper posture.

What's the importance of stretching and foam rolling?

photo 2I think of these things like maintenance.   You can't drive a car with a popped tired, and you won't know if your tire is popped unless you check.  Foam rolling and stretching both help your muscles recover and allow you to discover any knots or kinks you may have.  Both active and passive forms of recovery are important for athletes and active individuals.  Active recovery is both static and dynamic stretching, Passive is foam rolling and exploring with a lacrosse ball.  It allows your muscles to relax to avoid any knots or kinks that might occur in training.

Muscles only grow in size and strength with proper rest, nutrition and recovery.  Massage, stretching and foam rolling are integral parts of optimum recovery.

What do you do when aches, pains or injuries arise?

photo 3

Call you lol.  Use a lacrosse ball and stretch those areas.  For my shoulders, mostly hang from a bar in 90-second increments with both active and passive resistance.  Also periods of rest when necessary and massage definitely helps when I can’t get those persistent areas to calm down and ease up.

Fueling your body: typical day of meals like? I practice intermittent fasting.  Without going too far down the rabbit hole it helps minimizes insulin spikes, it doesn't work for everyone but it works for me.  I typically eat chicken, steak, rice, veggies, potatoes and guacamole.  I also allow myself a bowl of natural ice cream or a protein cookie for desert.

With the New Year upon us, any advice for people starting a new program or looking to change their routine up?

Don't overthink things; don't get too bogged down with information you read on the internet.  Just get up, go to the gym or get outside and do it again the next day, and the next day.  Do it until it's a habit and not hard to do.  Don't worry about getting on the "perfect program" or following anything.  Just show up, work hard and listen to your body. Things will fall into place after that.

They say 2016 is a new start, time for change and self-improvement.   Let’s all try to take better care of ourselves and make this our best year yet.

Patrick Henigan CPT

Pictures used with permission from P. Henigan

The Elusive Psoas!

Stand up, take a deep breath. On exhalation, draw your belly button to your spine – Do you feel your Psoas contracting?

The Psoas is a deep core muscle that works in conjunction with surrounding muscles to stabilize the lumbar spine and flex the hip. Together with the Iliacus, the Iliopsoas is an important low back stabilizer and strong hip flexor. Due to its deep location in the trunk, the Psoas can be difficult to isolate.




Origins: bodies and transverse process of the lumbar vertebrae Insertions: lesser trochanter of the femur, superior ramus of the pubis

Psoas 2


In Other Words…

The long muscle is located deep to the abdomen and connects the leg to the spine. It starts out as five little muscles attached to the sides and body of the lumbar vertebrae. Joining to form one muscle, it makes its way through the pelvis and attaches on the inside of the femur.


When do you use your Psoas?

The Psoas works in conjunction with other muscles to help you lift your leg in front of you, turn your foot out to the side and bend your lumbar spine to touch your toes. It also joins forces with the Iliacus to create the Iliopsoas, the ultimate spine stabilizer and the reason you can keep a steady warrior pose in yoga practice!

Hip flexion – walking or hiking up and incline, cycling Laterally rotate the hip – kicking a ball with the inside of your foot Flex the trunk towards the thigh – a forward back bend – reaching for your toes Tilt the pelvis anteriorly (major) and posteriorly (minor) – cat and cow poses

Psoas pain and tension

Pain related to Psoas dysfunction can manifest itself in different ways in your body. You may feel tightness or restrictions in your low back, tenderness in your hip area, or a pulling sensation at the area attachment on the femur.

Dysfunction can result from the following structural faults:

  • Tension in the muscle – overuse
  • Shortening of the muscle – posture (forward pelvis tilt)
  • Weakening of the psoas – overuse and posture (backward pelvis tilt)

Tension in the Psoas

Tension in the Psoas can stem from a range of activities that encompass repetitive hip flexion. Cycling, running hurdles, skiing, dancing, and hockey to name a few!

Shortened Psoas

Shortening occurs when the muscle is held in an incorrect posture for too long, be it a relaxed or contracted state. Sleeping in the fetal position or sitting for extended periods are factors that can contribute to the shortening of the Psoas.

Stressed or weakened Psoas

Tension in the supporting stabilizing muscles, for example the rectus abdominus and the glutes, can put excessive strain on the sturdy Psoas. This can lead to weakness, stress and fatigue in the Psoas. Greatly increasing your exercise program before the muscles have time to adjust, or training for extensive periods can be contributors to this stress.

Massage Therapy and the Psoas

A massage therapy session can help in relieving overuse tension causing back, hip or knee pain, as well as lengthening the muscle after it has been shortened due to poor posture. It will generally include massage and stretching techniques.


Because of its deep location, time must be spent warming the soft tissues surrounding the muscle before it can be palpated. Psoas work is conducted slowly and intently, with clear communication between Therapist and client.

The superior, or upper portion of the Psoas can be palpated and worked through the back, whilst the inferior, or lower portion of the muscle can be reached through the front of the hip. Although effective, Psoas work can be slightly sensitive and unpleasant!

In the instance of a stressed or weakened Psoas, massage can be effective without having to actually palpate the muscle itself. Instead, the supporting muscles are massaged (eg the rectus abdominus and the glutes). Relieving tension and correcting the posture of surrounding muscles will in turn reduce the amount of stress placed on the Psoas.


Stretching will assist in lengthening a shortened muscle. As the Psoas can be difficult to locate, stretching techniques can be challenging to execute by oneself; an assisted or facilitated stretch after warming up the muscles with massage is highly effective. More so, active stretching techniques such as AIS and PNF will effectively contract and relax the Psoas, providing a more targeted stretch.

Test #1

TEST #1: Check the strength of you Psoas

Stand against a wall to ensure that you do not cheat your Psoas by tilting your pelvis (therefore engaging your lower back muscles). Engage your Psoas, slowly raise one knee to a 90 degree angle, being careful to keep your hips square. Can you hold for 30 seconds?

    • If you are able to easily hold this position for 30 seconds, you have passed the test and have strength in your Psoas!
    • If you find it difficult or even impossible to hold this position for 30 seconds, you may have a weak Psoas and need to work on strengthening.


TEST #2: Check if your Psoas is shortened or holding tension

Lay on a table or bed with your feet dangling off the edge. Hug both knees back to your chest. Slowly extend one leg back to the table/bed, ensuring that you continue to hug the first leg tightly. Let your extended leg dangle off the table/bed. test #2 Does your leg lay flat on the table/bed?

      • If your leg is able to lay flat on the table, you have passed the test! However, if your psoas is weakened from the first test, you need to work on strengthening techniques.
      • If your upper leg does not lay flat on the table but you passed test #1, you have tension in your Psoas and need to work on stretching.
      • If you had trouble performing both tests, you have a weakened, shortened Psoas and need to work on lengthening (strengthening in conjunction with stretching).

Self care:

Stretching exercises for the Psoas

(Maintain a relaxed Psoas!)

lungeKnee lunge

Beginning in a kneeling position, bring your right leg out in front of you with your knee bent to a 90-degree angle. Contract the left glute. Lunge forward as far as you can go, being careful to keep your hips squared. HINT: your spine should be vertical – ensure that your ribcage is on the same vertical line as your hips. Too easy? Reach your arms up to the sky, arch your back. Still to easy? Grab your left wrist with your right hand, and gently pull your trunk towards the right.


Lay face down on the floor with your palms by your ribcage in a push-up position. Point your toes, engaging your quads. Gently raise your torso by extending your arms.

HINT: Try to keep your glutes relaxed and be careful not to shrug your shoulders!

Lengthening exercises for the Psoas

(These exercises combine both stretching and strengthening, and should be practiced in a fluid movement.)

side stretch

Side stretch

Start in a squat. Lean your right forearm on your right knee, extend your left arm to reach over your head at a 45-degree angle. Extend your left leg so that your left side creates a straight line from fingertips to toes. (This position contracts the Psoas, internal and external obliques on the right side, and stretches the Psoas, internal and external obliques on the left side.) Hold for three seconds, slowly move back to a squat and repeat on the opposite side. Continue with five repetitions.

modified catCat pose variation

Position yourself on the floor on your hands and knees. Bring one knee towards your nose, tucking your head down between your shoulders. (This position is contracting the abdominals, yet stretching the glutes). Reverse the exercise by extending your leg out behind you, straightening your knee, lifting your foot as high as you can, and arching your back to looking at the ceiling (this position is stretching the psoas and abdominals, and contracting the glutes). Continue with five repetitions.

Strengthening exercises for the Psoas

(Maintain a contracted Psoas!)

HINT: You should not feel your low back contracting. If you do, this means that your back has taken over the stabilization and your Psoas in no longer engaged! Adjust the exercise so that you can maintain contraction in the Psoas.

Leg liftsleg lifts

Lay on the floor with your legs at a 90-degree angle. Engage your Psoas, and slowly lower one leg towards the floor. Too difficult? Slightly bend your knees when lowering your legs. Too easy? Try two legs at once. Still too easy? Reverse the exercise by starting with your legs extended an inch above the floor and then raising them to a 90 degree angle.


Lay on the floor with your knees bent and feet flat on the floor, about a foot from your buttocks. Engage your Psoas and slowly bring your knees to your chest. Release your knees, maintain a bent leg, and bring your toes one inch from the ground. Continue with five repetitions.

single leg crunch

Single leg crunches

Lay on your back with your legs extended. Engage your psoas and hug one leg back to your chest. Hold for ten seconds. Then, let go, whilst trying to maintain the exact position of your bent leg. Hold for another ten seconds, before extending your leg to rest.



Now… Stand up, take a deep breath. On exhalation, draw your belly button to your spine – Do you feel your Psoas contracting?!


A Trail Guide to the Body Andrew Biel 5th Edition, publication date: 2014

Prenatal massage myths and facts

Even though we specialize in sports massage, and not prenatal massage, we get regular requests for prenatal massage by our members for themselves or their partners/spouses/friends.

Various aches can lead a mother to seek prenatal massage, and regular sessions can be very beneficial for the mother and baby. However there is a lot of misinformation about prenatal massage and therapist and client alike need to be adequately educated.

The aches and pains of pregnancy

Screen Shot 2015-09-28 at 4.21.03 PMThe body goes through many changes during pregnancy

One obvious change is the expanding belly that pulls the abdomen forward, increasing the curvature of the spine, but also pushes down on organs, blood vessels and nerves and creates more weight for your supporting joints to carry.

Another change is the secretion of a pregnancy hormone, Relaxin, that loosens up the ligaments around the joints so that the pelvis can expand during labor.

One more change: the body tends to retain more fluid during pregnancy [4].

Resulting pregnancy pains

The combination of the changes mentioned above often result in low back, hip and knee pain, as well as sciatic pain (this is when the Sciatic nerve is compressed, resulting in a tingling pain shooting from the hip down the back of the leg).

It can also cause swelling in ankles and legs. [5] [6] [7]

Prenatal massage helps ease those symptoms

Prenatal massage can help in relieving low back, hip or knee pain by using light to medium pressure to those areas. Other techniques, lymphatic drainage and light circulatory effleurage, can help reduce swelling to the legs. While certain lotions may be applied to the abdomen for hydration purposes and some other abdominal techniques can be used to relax the Mom and to relieve low back pain, generally this area is avoided during a massage session. Rather the session will focus on the back, hips and legs as well as neck or arms if indicated.

Massage during the first trimester

“You may not be announcing your pregnancy to your family and friends at this stage, but it is crucial that you do so to your therapist as soon as you find out you’re pregnant so they can adapt their session. “

Prenatal massage may be done during all trimesters, with the approval of the obstetrician (OB) and with a professional massage therapist, preferably certified in prenatal massage.

Some therapists refuse to provide treatment during the first term due to the risk of miscarriage associated with the first 12 weeks of pregnancy; however that risk is not linked to massage as long as there is the green light from the OB and that the massage is performed by a licensed professional [1].

In the first term, some mothers suffering from important nausea may not be comfortable receiving a massage, while it may not be an issue for others. Communicating with your therapist before and during the session (preferred position, sensitivity to certain smells or oils, etc) and preparing for the session (light snack before hand, being hydrated) may help keep nausea at bay [9].

Second and third trimester: side lying position

[15]  After the first trimester, the massage is performed in a side lying position to avoid pressure on the major vein and arteries that run down the spine behind the uterus. If this position is not comfortable, the massage can be done sitting back with a pillow to elevate the back. Prenatal practices may offer a face down

[15] position with a table that has a hole cut out to fit the abdomen, however this is not a preferable option as it may still put pressure on the uterus [1].

Some therapists avoid massaging the ankle because of a pressure point that is said to trigger labor (another pressure point would be on the hand between the thumb and index). On the contrary, some pregnant women massage that point at the end of their pregnancy in the hope that it will trigger the baby’s arrival. However this is a widely spread theory that stems from acupuncture/acupressure, a modality that has no basis in modern medicine and whose efficacy has not been proven, in spite of thousands of clinical trials.  [10] [11] [12] [13] [14]

Research and prenatal massage

There are several interesting research papers that have come out studying the effects of prenatal massage.

A study [2] where women were offered regular prenatal massage showed reduced anxiety, reduced pain, decreased complications during labor and decreased incidence of prematurity.

Similarly, another study [9] on women receiving regular prenatal massage associated with yoga showed reduced anxiety, depression, back and leg pain and greater gestational age and birthweight.

Yet another study [3] on depressed women receiving regular prenatal massage showed reduced depression and reduced incidences of prematurity and low birthweight.

Prenatal massage is a great tool to relieve pregnancy pains as well as to participate in a healthier pregnancy and delivery and it can also benefit the newborn. Your therapist will also discuss self-care tools such as using a belly belt during certain activities, correcting your posture during the day and using a body pillow at night; stretching and strengthening can also be beneficial, with your OB’s clearance.

"If you are looking for a prenatal massage, I recommend seeking a prenatal massage specialist that will have a set-up tailored to pregnant women. However, if you feel more comfortable working with a therapist you or your friend/spouse/partner trusts at Phila Massages, be assured that all of our therapists have basic training in prenatal massage (as required by our PA licensure); with one being a certified prenatal and infant massage therapist and another having interned in a high-risk maternity ward. "

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